Author: Ethan(page 1 of 2)

When people come into the office that have conflict around sex, my first question is often whether they are trying to have the same conversation or two separate ones.

It can be tremendously challenging to validate your partner(s)’ experience or meet a need if you aren’t sure what that experience is, but are making an assumption around what you think they are saying they need.
When trying to communicate about sex, assumptions about your partner(s)’ experience can get you into trouble. Assuming sexual preferences, what is consensual, what’s erotic, what fantasies look like, what preferable touch feels like, what is a turn on, and what helps keep your them feeling safe can lead to hurt and disappointment, as well as a lack of understanding and invalidation.

To help avoid these assumptions when trying to understand clients(s) sexual experiences in the office, I often ask everyone to consider delineating their sexual needs (which we define here as pleasure) and intimacy needs (which we define here as emotional closeness). These experiences are often interrelated, but don’t have to be. They can also be confused or lumped together in an unclear way leading to assumptions being made. Teasing them apart can help clarify sexual needs and lessen sexual conflicts.

Understanding you and your partner(s) sexual identity through the lenses of both physical pleasure and emotional closeness can help clarify experiences and lead you to knowing your partner(s) better. Thinking about sex and intimacy at two interrelated components of sexual experiences can provide a useful jumping off point to understand what helps your partner(s) feel safe, valued, and a priority, as well as what helps them feel good in their body.

Again, it can be difficult to prioritize an experience or need for someone we value if we don’t clearly understand the need in the first place. Conversations around sexuality can (at times) be challenging. Discussing sex and intimacy as different parts of our sexual experience can be a useful tool for clarifying needs between partners, and understanding one another better.

Do you feel that you know your partner(s)’ sexual interests as well as how they experience intimacy?

If you or your partner(s) are struggling with clearly communicating sexual preferences as well as what helps build emotional closeness, sex therapy can help!

Often, couples and partnerships come into the office because of a desire discrepancy or an erotic conflict. As these differences in sexual interests or preferences can be distressing if unresolved, many clients come in initially and report that their sexual needs are not validated or valued to begin with by their partner(s).

This can be especially common when one person’s sexual needs or preferences are atypical and the other(s)’ are not. Often, leading to someone feeling as though their sexual experiences are less valuable or “normal.”

One of the most challenging issues I see with clients who are in romantic relationships is learning how to validate one another’s experiences and disagree…without feeling as though their character or identity are on trial. When sexual differences exists, this can be challenging. When validation does not happen, it can lead the un-validated party to feel less than, or broken, or that their sexual interests or sexual identity are dysfunctional.

As this is a common occurrence, there are many conflict resolution and communication tools in couple/partner therapy that can provide a structure for understanding the experiences of your partner(s) in a way that allows her/him/they to express their needs and ultimately leave feeling as though their identity is valued.

While this process can seem daunting, learning to validate the sexual interests of your partner(s) shows concern for their experience. Valuing the experience of the other can lead to further autonomy, differentiation, and a more secure attachment between romantic partners.

Do you feel you value and ultimately validate your partner(s)’ differing sexual interests and preferences?

Are you or your partner(s) struggling with validating or valuing one another’s sexual experiences or practices? If you are trying to get on common ground or find common sexual ground, sex therapy can help!

Call Dr. Ethan Schwab today at (425) 295-2189 for a FREE initial consultation. Learn to collaborate and create new opportunities to ensure sex stays a priority.

Often, clients are referred into the office with an issue around sexual function (e.g., early ejaculation, delayed ejaculation, desire discrepancy, and low desire). When discussing client goals, individuals and partnerships will commonly identify a concrete outcome or level of performance they would like to be at or reach to be sexually healthy again.

Clinically, in many arenas of sexuality, normalcy or sexual function is defined by the individual, relationship, or partnership. Despite clients having the capacity to determine their own levels of sexual health and sexual success, social norms powerfully dictate what we “should be” or “should be doing.” Given the regularity of clients believing they should have one particular type of sexual success, I often encourage people in the office to consider what might be most preferable for them. Could there be alternative to what is socially normative that could be a better fit? If so, what could that look like? Why would an alternative be a more preferable form of sexuality or sexual function?

For example, in the case of desire discrepancy (the most common sex therapy presenting issue), could different types of desire or interest be a strength in the relationship? Do you need to have perfectly compatible sexual interests to have sexual success or health between partners? Can differences open furthered sexual dialog or exploration?

Ideally, choosing one’s own version and creating an alternative narrative around sexual success can be freeing and open the dialog to more preferable sexual interactions. Defining what sexual success looks like for yourself, and collaborating with your partner(s) to create meaningful and pleasurable outcomes can help reorient toward sexual health.

Are you or your partner(s) struggling with defining preferable sexual success? If you are trying to get on common ground or find common sexual ground, sex therapy can help!

Call Dr. Ethan Schwab today at (425) 295-2189 for a FREE initial consultation. Learn to collaborate and create new opportunities to ensure a preferable definition of sexual success.

Many clients at my office come in struggling with boundaries. Often, when something sexual is new and available, we can get a little carried away, over excited, or overzealous prior to establishing clear boundaries around sexual play with our partner(s). This has gotten many relationships into trouble. Erotic conflicts (sexual conflicts of interest) can leave partners feeling alienated, wondering if their sexual needs and wants will be met, or whether their personal boundaries will be respected.

When couples and partnerships come in hoping to bridge the gap between different sexual preferences, are looking to explore a new sexual avenue, or even open their relationship, creating a structure and expectations for individual and shared sexuality is paramount. It is not uncommon for many individuals to have differing sexual needs and desires. Clearly understanding the meaning behind these needs helps to clarify how the relationship can support each individual feeling authentic and alive (sexually), as well as establish what each partner is comfortable with and what they are not.

For instance, if you are newly interested in power play (someone being dominant, another being submissive), establishing the role of each participant, understanding the type and purpose of the play, attaining consent from your partner, and developing clear and collaborative boundaries that protect and ensure the limits of the experience for each person can help the relationship build safety. Without creating a structure and agreed upon set of expectations for sexual play, assumptions can get the better of people and ruin experiences, and at times, even create trauma.

If you find yourself in a new partnership, or in a situation were clear sexual boundaries have not been established, collaborating with your partner to develop limits where each of your needs can be met can help bring clarity to the relationship and lessen sexual pressures. While creating rules, boundaries, expectations, and new understandings of one another’s sexuality is tremendously useful, there are many times where partner preferences or sexual needs are beyond another’s limits. Relationship conflicts can arise. Stay tuned for a brief discussion of mismatched sexual preferences where your partner’s sexual needs are beyond your comfort zone, or are a deal breaker.

Are you and your partner(s) struggling with establishing clear and collaborative sexual boundaries? If you are trying to get on the same page or find common sexual ground, sex therapy can help!

Call Dr. Ethan Schwab today at (425) 295-2189 for a FREE initial consultation. Learn to collaborate and create new opportunities to ensure sex stays a priority.

Very few clients I see love the idea of having to schedule sex to ensure it has a place in their relationship. It certainly isn’t a glamorous idea…Not at face value. Regardless, many couples and partnerships struggle to find time or energy (whether physical or emotional) to engage in sex play by the end of a long work day. Most people (especially in Seattle) are busy these days. Work, errands, parenting responsibilities, friends, work, family, volunteer opportunities, finding time for fun, and work all can unintentionally take priority over physical intimacy. Everything else becomes a priority. Did I mention work?…

While it can be challenging, there is no reason to follow any social rule about how sex “should be” in a relationship. Few individuals, couples, and partnerships want to admit they feel too exhausted for any sex play. Scheduling a time for sex can provide an open forum for diverse sexual play. Additionally, it can provide a time during the week for novel sexual exploration, giving each partner a turn to bringing something new to the sexual buffet. Many people struggle with the notion of losing sexual spontaneity, and having another calendar item to schedule during the week.

Contrary to common concerns, having a predictable time where sexual play is guaranteed can keep sex on the mind when it might not otherwise be. Often, one planned time and space can help inspire additional spontaneous sex throughout the week. Additionally, creating an opportunity to rid the relationship of anxiety, stress, disappointment, or the feeling of failure around not having regular sex can create space for building further safety around initiating sex (especially if initiation has been infrequent or challenging).

Are you and your partner(s) struggling with low frequency? If you are trying to get on the same page or find common sexual ground, sex therapy can help!

Call Dr. Ethan Schwab today at (425) 295-2189 for a FREE initial consultation. Learn to collaborate and create new opportunities to ensure sex stays a priority.

Often, I have couples and partnerships come into my office reporting that all of a sudden (or, in many cases, slowly over time) one partner has lost their drive to engage in sexual play. While desire discrepancy is common, it can be unnerving, especially if bids for affection or sexual initiations on your part have been unsuccessful leaving everyone involved feeling potentially disconnected or humiliated.

In many instances, before a solution can be formulated or you understand the origin of the problem, anxiety gets a strangle hold over the relationship and communication breaks down. Constructive conflicts become quickly triggered fights, and often are not productive or go in circles where one partner expresses their need for sexual connection, and the other seems apathetic about sex or anhedonic (he/she/they do not seem to experience pleasure in life).

Prior to making progress in psychotherapy, physiological issues (e.g., hormone levels, other medical disorders…etc.) and co-occurring disorders (e.g., depressive episodes/mood disorders) should be ruled out or determined to be a part of the cause. Afterword, psychotherapy/sex therapy can commonly be helpful in discovering what is impacting the individual and rebuilding or discovering new or old arenas that provide pleasure in the relationship.

Cases of desire discrepancy are common, and require clear communication of boundaries, expectations and sexual (physical and emotional) preferences of all partners in the relationship to be overt and well negotiated. Rebuilding an open line of communication, with the addition on a number of intervention techniques (e.g., sensate touch, trying new sexual activities, discussing fantasies, attempting to stage a novel sexual scene…among many, many others) to be practiced at home can help reform pleasurable sexuality in the relationship.

Regardless, rigid or strong expectations can be crippling, leading the individual with low/no desire to feel incompetent and valueless, further continuing the potential cycle of initiation/shutdown/disinterest/resentment. Don’t let a lack of clear communication around desire destroy pleasure in your relationship.

Are you and your partner(s) struggling with a desire discrepancy? Are you trying to get on the same page or find common sexual ground? Sex therapy can help!

Often times in my office and in my classrooms, clients, students, and general practice therapists struggle to identify the difference between a kink and fetish. To begin, a kink is any type of atypical sexual play that you enjoy. This can be anything from BDSM (or some type of play using or manipulating power for pleasure purposes) to chastity. Alternatively, a fetish is a type of sex play that is required for sexual arousal or gratification. This typically focuses around excitement toward an object or body part that is not traditionally identified as sexual in nature. A commonly thought of example is a fetish pertaining to feet, where seeing, touching, or smelling a foot (of some particular variety) would be necessary for arousal. Fetishes are wide sweeping and can range from leather to exposing oneself sexually in public (exobitionism).

Most fetishes, when play is consensual, are completely legal and not pathological in any way (e.g., with the exception (in WA State) of Frotteurism, Bestiality, Voyeurism, Exobitionism, Hebephilia, Ephebophilia, and Pedophilia).

Many individuals, couples, partnerships, and play partnerships regularly enjoy both kink and fetish play. Working toward incorporating this play can be challenging if a partner is inexperienced, the play is new, or there is confusion around the impact of the play on the relationship.

If you are struggling through working on identifying, negotiating, or learning about a kink or fetish by yourself or with a partner, sex therapy can help.

A wildly common case in sex therapy practices is early ejaculation (formerly known as premature ejaculation). While the thought of orgasming with your partner too early during sexual play can seem embarrassing, shameful, or leaving you worrying about his or her enjoyment, know that you are not alone and are not a rarity.

While there is generally not one specific cause for all early ejaculation cases, psychological and physiological factors may be impacting performance. I always recommend to all men, that prior to beginning (or at the beginning of sex therapy) to visit your urologist (if you do not have one, either your primary care provider, or myself can make a recommendation) and rule out potential medical issues. Examples of physiological causes are: pelvic floor issues, hormonal imbalance, and inflammation of the prostate. When early ejaculation is psychological in nature, anxiety, relationship issues, pressure to perform, or even erectile dysfunction can be in play.

If you worry about performance and subconsciously rush to complete sex, orgasm can happen quickly. Additionally, the expectations of your partner can have a great deal of impact on remaining mindful and present mentally during sexual experiences.

Given the range of potential reasons early ejaculation may occur, ruling out either biological or psychological issues in initially paramount. After, many interventions exist that are evidence-based and time proven to delay ejaculation.

The following are just two of a handful of strategies that are commonly prescribed by an AASECT certified sex therapist to aid in building control over ejaculatory response:

Edging: Masturbating up to just before orgasm and stopping prior to ejaculation, taking a break (letting the erection subside a little), and then starting masturbation again. This allows you predict when you are close to orgasm and being able to identify when you need to slow down or take a break prior to continuing masturbation (and inevitably sex). This also allows the opportunity to delay ejaculation as you become more familiar with sensations, ultimately desensitizing your experience with masturbation and sex. This can replicated during oral or penetrative sex by stopping penetration and taking a break or focusing on your partner.

Pause/Squeeze Technique: Masturbating up to just before orgasm (like above), but instead of stopping masturbating and taking a break prior to restarting, here you will grab and hold the shaft of the penis snugly (just below the head) just prior to ejaculation. This helps stop orgasm through dulling sensation. After, either masturbation or sexual play can continue…lengthening the sexual play.

If you have found yourself struggling with Early Ejaculation and want to work toward building strategies that will be effective for delaying ejaculation, sex therapy can help.

Male and female orgasmic disorder (formally anorgasmia (primary or secondary)) is a sexual dysfunction where an individual struggles to achieve orgasm or has lost the ability to achieve orgasm during sexual play (whether with a partner or during solo masturbation). Many individuals with these symptoms experience anxiety around initiating sex with a partner, and may feel guilty or shameful for not being “normal.” While statistically more common in females, a lack of ability to achieve orgasm/orgasm loss can be due to a number of things.
For instance, antidepressants (SSRI variety) may impact ability to orgasm. Additionally, general anxiety around sexuality, beliefs around sexuality and normal sexual practice, or a lack of sexual knowledge can impact ability to orgasm for the first time.

A significant number of individuals (both male and female) experience; a general inability to achieve orgasm or haven’t in life (with or without a partner), situational issues with orgasm (with or without a partner), or acquired issues with orgasm (where you were able to achieve orgasm at one point, but no longer possess the capacity to do so).

Differing interventions and treatment programs exist for each orgasmic issue outlined in the paragraph above, from medical intervention to psychological treatment. Quelling anxiety, potentially changing medications, familiarizing oneself with one’s anatomy, understanding what is sexually and physically stimulating through body touch and masturbation, generally understanding your body better, relationship counseling, and mindfulness-based stress reduction can all be effective strategies for helping achieve a preferable orgasm alone and with a partner.

Sex therapy and related interventions have been shown to be effective in helping treat male and female orgasm issues.

If you have found yourself struggling with difficulty achieving orgasm sex therapy can help.

Seattle life is hectic, and at times hellish these days. We balance work, friends, hobbies, family, children, our intimate relationship(s) and our sexualities. We expect a lot from ourselves, and in turn (often) expect a lot from others. Often, by the end of each day though, we’re physically and emotionally exhausted.
Given the wide array of obligations we involve ourselves in, creating opportunities for quality time in romantic relationships becomes paramount. Unfortunately, and often unintentionally, we deprioritize our romantic partners as life piles up.

When I was young, I couldn’t stand the idea of “date night.” The notion of having had to plan time with my partner, rather than have everything happen spontaneously was a real bummer. Wow…I was ignorant. As time has gone on, and responsibilities have amassed, finding and creating opportunities for quality time helps keep intimate relationships at the forefront of life (and gives you something to look forward to with your partner on a regular basis).

With all of the couples and partnerships I see, regardless of presenting problem (whether a relationship or sexual issue), encouraging setting out time during the week to plan something to look forward to is always a high priority. Having a date night, or game night, or planning time for sex with your spouse(s) can be tremendously beneficial and creates an opportunity to reconnect, creates shared meaning, and a forum for building on the relationship. Regardless, many challenges exist. Start by finding a time to invest in the relationship intentionally.

An upcoming discussion of strategies to implement to ensure quality time to follow.

If you have found yourself struggling with an issue(s) around sexuality, or in your relationship, sex or relationship therapy can help.

For sex or relationship therapy, Call Dr. Ethan Schwab today at (425) 295-2189 for a FREE initial consultation. Learn to be yourself, as fulfilled and healthy as possible.

In all states, with the exception of Florida, any mental health care provider can label him/herself as a “sex therapist.” Most individuals doing so possess little to no education in the field of human sexuality (especially with regard to issues impacting sexual functioning). Morals, values, and personal experiences impact and often lead the perception and judgement of these therapists, negatively impacting or harming the client(s).

Ensuring that the therapist has graduate training and licensure at either the masters or doctoral level in Marriage and Family Therapy, Psychology, Social Work, or Licensed Professional Counseling is a good initial step in establishing a qualified general practitioner. If you are working on or struggling with a sex problem or dysfunction, confirming the therapist is a certified sex therapist is key. Knowing the practitioner has met the American Association for Sexuality Education, Counseling, and Therapy’s (AASECT) standards for training and supervision in advanced issues of sexuality guarantees a minimum level of competence. Training standards to become an AASECT certified sex therapist are rigorous.

Requirements are as follows to attain certification as a qualified sex therapist:

• Minimum clinical training in one of the above fields at the masters level
• A minimum of 300 clinical hours of treating sex concerns
• A minimum of 50 hours of sex therapy specific supervision
• A minimum of 90 hours of human sexuality education
• A minimum of 60 hours of specialty training in sex therapy
• A minimum of one, 10 hour sexual attitude reassessment seminar to assess and challenge therapist biases and assumptions

Certified sex therapists possess the highest training standard and are held to a level of rigor general practitioners claiming expertise in sexuality do not. If possible, I always encourage clients to review the education, training, and experience of each therapist being interviewed prior to selecting a provider. Therapy, and especially sex therapy, are about fit. Ensure you invest time with a therapist that honors your preferences and can thoroughly help you and your partner(s) address your sexual concerns.

If you have found yourself researching sex therapy or sex therapists, ensure the provider you are choosing is not only a good fit for yourself and your relationship, but thoroughly trained in the presenting issue(s).

For sex or relationship therapy, Call Dr. Ethan Schwab today at (425) 295-2189 for a FREE initial consultation. Learn to be yourself, as fulfilled and healthy as possible.

When relationships end, (especially romantic or sexual ones) we often struggle to maintain friendships or create shared meaning with our former partner(s) or spouse while transitioning out of the relationship. We go our separate ways. We split assets. We fight. We scream. We show little dignity or compassion. We share the dog. We allow anger, disappointment, fear, and dissolution to fill us.

I see this happen regularly out in the world, but differently in my clinical practice. Clients who have chosen to end relationships during therapy, (due to infidelity, differing sexual preferences, different relationship desires, monogamy vs. non-monogamy, or just growing apart) find themselves in a place where there is an opportunity to end the relationship well. This process is not void of sorry, melancholy, or hardship, but couples/partner therapy can be an excellent way to reconcile differences and create a meaningful friendship or respectful transitions out of each other’s lives, after the romantic component of the relationship has ended.

Even in situations where one or all of the participants in the relationship feel badly hurt or slighted, there are many ways to find meaningful resolution without cutting the relationship completely off (unless this is most preferable for the individual(s), or necessary for safety or moving forward). This is not to say that you and your former spouse will be best friends, but that you can look back on the relationship and distinguish preferable relational qualities. Moving forward, these experiences can support future development and authenticity in subsequent intimate relationships.

Inevitably, in situations where relationships end under hurt and sorrow, finding loving kindness for someone can be a useful way to find resolution. Not desiring a future relationship of any sort with your former partner may be the best option, but having means to end the relationship preferably (with tact, dignity, and respect), wishing your partner well, can help all of those involved move forward in an authentic and meaningful way.

If you have found yourself struggling to end your relationship and want to create a meaningful transition with your partner full of forgiveness and heart, relationship therapy can help!

For sex or relationship therapy, Call Dr. Ethan Schwab today at (425) 295-2189 for a FREE initial consultation. Learn to be yourself, as fulfilled and healthy as possible.

We interrupt normal blogging topics to bring a quick, special bulletin on using personal lubricant with sex toys. It’s come to my attention that many individuals out on the sexual landscape do not understand key differences between types of personal lubricants and when each would be best employed. For the purposes of this discussion (for now), we will stick to just water and silicone-based (barring all natural lubricants…e.g., olive or coconut oil for another conversation).

Depending on personal preferences, silicone (glycerin and paraben free for vulvar health) lubricants are often the choice for many women and men due to their inherent advantages. Silicone lubricants do not fade away as quickly as water-based, and often last (during sex or sexual play) far longer than their water-based alternatives regularly available for purchase at local drug stores.

Regardless, if you enjoy the usage of silicone constructed sex toys for masturbation or play with a partner(s), ensure you use only water-based or organic options. If using silicone-based lubricant with (silicone) constructed toys, the silicone itself from each will inevitably fuse and ruin the material of your (often expensive) vibrators, dildos, plugs…etc. Be weary, to ensure you are selecting a compatible lubricant with these types of sexual play.

Stay tuned for a soon to come (in-depth) discussion of personal lubricants and their health and play advantages and disadvantages.

If you have found yourself researching new sex toys and aids, stay tuned for an in-depth discussion of physiological health and what to use.

For sex or relationship therapy, Call Dr. Ethan Schwab today at (425) 295-2189 for a FREE initial consultation. Learn to be yourself, as fulfilled and healthy as possible.

While life in Seattle is complicated enough today, adding sexual dysfunction in addition to managing your relationship can be tremendously challenging. Many clients I see have tried the kitchen sink to “fix” what’s wrong in their relationship or sex life, to no avail. Like the last post in this thread began to discuss, living an authentic life can be challenging, but always ideal.

Solving sexual problems can seem and become daunting when the solutions you’ve searched for in self-help guides or online forums don’t work. Often, clients come for sex or relationship therapy as their last resort, rather than an initial intervention, often understandably so. For instance, if you or your partner is suffering from Early Ejaculation (also known as Premature Ejaculation), you may go above and beyond to lengthen sexual experiences with one another by any means necessary in the privacy of your own home. I fully appreciate the societal stigma and shame associated with having to ask for professional help outside of the relationship in hopes of lasting longer before ejaculating (or for solving any other sexual dysfunction). No one wants to feel incompetent in their own body.

The thought of going to therapy can seem emasculating, daunting, or plain overwhelming. Regardless, many sexual dysfunctions are commonly treatable through either psychotherapy (sex therapy) or with medical collaboration. If you’ve struggled, or your relationship has suffered at the hand or early ejaculation, performance anxiety, erectile dysfunction, painful sex, or the inability to orgasm, sex therapy could be helpful.

If you have found yourself at this point in life, where you not only have relationship or sexual problems, but want to approach life as your most authentic self, couples and/or sex therapy can help!

Call Dr. Ethan Schwab today at (425) 295-2189 for a FREE initial consultation. Learn to be yourself, as fulfilled and healthy as possible.

Thinking back on all of the individuals, couples/partnerships, and families I’ve seen and worked with in the past decade, I’ve noticed a consistent trend. No matter the content of the case, what brings someone into my office, or their presenting problem, their goals always boil down to one thing: living an authentic life.

Regardless of what someone’s relationship or sexual preferences look like, in the end, they almost always want to be accepted and celebrated for being who they are, especially by those they love. This prospect can feel like fighting the tide. Social and cultural norms are often out of line with who we are or would prefer to be.

I tell clients regularly that they are the most “normal” people I know, and it’s true. The individuals that frequent my office are intentional and genuine people choosing their paths in the most preferable ways possible…being more authentic. It may seem rantish, soap-boxy or cliché, but being comfortable with who you are and celebrating your uniqueness rather than letting others convince you that you are odd, weird, or pathological (especially if there is no clinical pathology present) is a phenomenally masterful skill these days.

Plenty of situations get us down on ourselves, or we try to change who we are to make everyone around us comfortable. But, at the end of the day, finding community and partnerships where you can be genuine is paramount. Working toward solving the problems that bring you/your partner(s) to therapy happens best and most effectively if you have this type of dynamic present in your relationship, where those around you know you at your core…and love you for it.

—More on this topic to come—

If you have found yourself at this point in life, where you not only have relationship or sexual problems, but want to approach life as your most authentic self, couples and/or sex therapy can help!

Call Dr. Ethan Schwab today at (425) 295-2189 for a FREE initial consultation. Learn to be yourself, as authentically as possible.

What happens when you find yourself in a position where your partner(s) wants to either open the relationship sexually or change the format from monogamy unexpectedly? What if he or she wants to share their heart and capacity for love with other partners in addition to their bed, in addition to you? For many people these partner realizations or needs can rock their world, leave them bewildered, or put them in a state of grieving or mourning the loss of what they believed their relationship to be. For others, it’s right up their alley.

If you’re either someone who prefers monogamy, or someone who prefers polyamory, or prefers a monogamous emotionally intimate relationship, but sexually open, hope is not lost if your partner(s) doesn’t feel the same. Different expectations don’t necessarily mean incompatibility. I commonly see many couples and partnerships where each member possesses differing expectations about the nature of the relationship based on individual needs, hopes, and desires for their romantic and sexual lives.

Ultimately, everyone I see desires to be authentic and genuine. Advocating for what would facilitate these qualities with your partner(s) or in your relationship can be challenging if the relationship structure you require (to feel alive) is not what the other(s) prefers (or believes to be correct/true).

Indecently, as discrepancies in structure, preference, and expectation can take place in many arenas of all relationships, creating a new narrative for the couple or partnership can be a successful and useful intervention for reshaping the future of what each person will share with the other. You do not need to become overwhelmed or consumed with the feeling of chaos if your partner(s) wants to change the relationship structure out of the blue.

While this can certainly be challenging, requiring a processing of the loss of prior hopes and expectations, it does not mean you and your partner(s) are doomed to divorce/relationship dissolution. Many people have found ways to co-create a new and novel story for themselves that is preferable (and often initially unexpected), that facilitates the hopes and authenticity of each member of the relationship.

If you have found yourself in a situation like this, where you either need to change the structure of the relationship for it to continue or break up to meet needs and/or expectations, but still want to share and create a life together, don’t wait until communication and the relationship itself gets worse! Couples and/or sex therapy can help!

Call Dr. Ethan Schwab today at (425) 295-2189 for a FREE initial consultation. Learn to be yourself, as authentically as possible.

November 30, 2015 / Ethan / Comments Off on Getting it Up: Struggles with You or Your Partner(s)’ Erectile Function.

We talk about it all of the time at my office. What happens when your or your partner’s drive for penetrative sex is there, but you/he isn’t standing at full attention, ready to join the party? Psychogenic erectile dysfunction is tremendously common, yet immensely frustrating. There isn’t anything much worse than having the overwhelming desire to have sex, but not being able to “rise” to the occasion.

Many problems can get in the way (have a look at Performance and Loss of Erotic Focus below), as anxiety and stress can kill even the most determined “soldier.” Regardless, issues maintaining an erection during penetrative sex can leave you or your partner feeling lost, or wondering if you really are attracted to him or her, or vise versa. Often, this is luckily not the case (as many partners who stay together have great sexual attractions for one another).

So the question becomes, how do you get rid of the elephant in the room (seeing as how it’s not invited)? Introduce it. The best initial outcome for anyone in a sexual relationship where one or more partners has a loss of erectile function, is to create clear and open communication around the problem, goals, desires, and expectations. If you can get on the same page, managing the sexual dysfunction is far simpler. Sex were erectile functioning has been an issue can cause many interpersonal problems within the relationship leaving each partner feeling uncared for or even unloved or desired.

If you have found yourself in a situation like this, or have found that your partner(s) has struggles with erectile function, but still wants to have sex, don’t wait until communication and the relationship itself gets worse! Your sex life is not destined for failure. Couples and/or sex therapy can help!

Call Dr. Ethan Schwab today at (425) 295-2189 for a FREE initial consultation. Learn to be yourself, as authentically as possible.

What happens when find yourself in a long term relationship where your partner discloses that you aren’t the sexual “apple of their eye” or ends up cheating, but tells you that it happened because they really aren’t monogamous? Surprise…non-monogamy! This is a hard question to ponder after the fact, while trying to understand what happened in your relationship that led to the late-term disclosure or affair. Sometimes, it’s difficult to even believe this could be true, as it can sound like an excuse the first time you hear it.

As we have come to understand monogamy and non-monogamy further, we are realizing that many individuals struggle to identify, share, and accept their true sexual identities. Unfortunately, this lack of early disclosure often results in negative relationship consequences. Usually, partners, husbands, wives…etc., struggle to inform their spouse(s) early in the relationship of their sexual preferences (if not typical or commonly accepted socially) out of fear. They worry they will lose an otherwise successful and inspiring romantic relationship or best friendship. They worry about being shamed, or will experience guilt over not being “normal.”

It can be difficult to believe that your partner(s) lied over the course of the relationship or cheated out of “necessity,” or because it is just who they are (to be authentic, feel alive, or be true to themselves). However, in cases where one partner cheats because they aren’t monogamous, but are attempting to maintain a monogamous relationship, it can seem like there is no hope for the relationship…or like you’ve been smacked in the face twice (see: double whammy). Regardless, these situations are often lined with hope and tremendous opportunities to develop better, clearer, and more honest communication in the relationship. If the adultery or lack of preference disclosure can be reconciled, there are many positive directions we can work toward to better each member of the relationship’s lives. Your relationship does not have to end if you are partnered with someone who is non-monogamous or vice versa. There are many ways to reconcile this difference and create a very authentic, genuine relationship moving forward, filled with trust, honesty, compassion, admiration, and love.

If you have found yourself in a situation like this, or have found that your partner(s) has other preferences with regards to monogamy (or the openness of your relationship). Or vice versa. Your relationship is not destined for failure. Couples and/or sex therapy can help!

Call Dr. Ethan Schwab today at (425) 295-2189 for a FREE initial consultation. Learn to be yourself, as authentically as possible.

I hear that word in my office all of the time. “Performance.” We’ve all heard it forever. At work, at school, while on sports teams, or even playing board games…the thought that we “must” perform (as if there is an ultimate or universal standard) applies. While judging performance may be useful in a work or school setting, what happens when you feel judged or judge yourself in the bedroom?

How do you know what good enough, great, or stellar looks like for yourself and/or your partner? What if you begin to doubt yourself or your competence as a sexual being? What if you think or have been told that you don’t perform well in the relationship…or in bed? In many instances, erectile dysfunction or trouble achieving orgasm (in men and women) can occur as a result of experiencing ongoing worry, stress, or anxiety over sexual performance.
Sometimes, despite having great communication with our current partner(s) around sexuality, old experiences creep in. Maybe you once heard something negative, or that a man or woman should perform sexually in a specific way, or that something didn’t look good or wasn’t “the right size.” Or…be willing to engage in sexual behavior that is inauthentic to who you are or what you believe is right for yourself.

Maybe the notion of being a good “performer” starts when we’re young. We look at the most popular or successful seeming people around us and copy his or her actions in hopes of replicating a desired result. The problem with thinking about sexual prowess or performance from a social learning perspective is that there are many examples of sexual standards for men and women that are either out of left field, or blatantly inaccurate, but…set a high bar for what we expect from ourselves. Learning to be authentic and have expectations be preferable and realistic is a constant, intentional process. With a little work, we can see ourselves as rock stars in our relationships (or in our own sexuality). Learning how to be authentic and honest with ourselves is key.

If you find yourself or partner worrying about performance, and want to work toward feeling confident and competent in all areas of the bedroom, couples and/or sex therapy can help!

Call Dr. Ethan Schwab today at (425) 295-2189 for a FREE initial consultation. Learn to be yourself, as authentically as possible.

Have you ever found yourself in a situation during any type of sexual activity (either by yourself or with your partner(s)) where you are mentally present and in the moment, but then all of a sudden lose focus on the situation at hand (where your desire, erection, or orgasm is compromised)…maybe you think about the dishwasher running, the kids needing to be picked up at school, a work event later, whether you look sexy enough, or the garage door being open? We all lost focus from time to time, or are “just not that into it” in certain moments. Sometimes however, loss of erotic focus happens regularly, and significantly diminishes the joy and pleasure of sexual experiences with or between you or your partner. Losing focus consistently during any sexual event, whether masturbation or intercourse can lead to problems with orgasm (male or female orgasmic dysfunction), or even erectile dysfunction.

Many, many issues can lead to a loss of erotic focus, from a too stressful or overly extended life to first time parenting. If you find yourself struggling to stay present during sex or masturbation, and are experiencing difficulty with orgasm, erectile function, or general sensory pleasure, sex therapy can help. There are many techniques that are useful in focusing back in on the experience at hand, and help with gaining mastery over your sexual response.

A helpful beginning strategy for staying present in the bedroom is practicing mindfulness.

• Mindfulness-based Stress Reduction is a form of mindfulness that is clinically aimed at lowering anxiety through attentive breathing exercises, body scans, guided meditations, as well as other practices.

• The point here is to work toward lowering anxiety and remaining present in any situation without “checking out or drifting.”

• Start with the 4-7-8 breathing exercise, also known as Mindful Breath. There are many great examples of the 4-7-8 breathing exercise online. It only takes a minute or two to practice. I often suggest all clients start here prior to taking on more intensive meditative techniques.

If you find yourself or partner struggling with a loss of erotic focus during sex, and want to work toward reconnecting and becoming present in the bedroom, couples and/or sex therapy can help!

Call Dr. Ethan Schwab today at (425) 295-2189 for a FREE initial consultation. Learn to communicate your boundaries, preferences, fantasies, and what is erotic in ways that are safe, secure, considerate, and welcomed by your partner.

Often these days, I find myself sitting in front of all sorts of different couples where a new passion or sexual/relationship preference has emerged from one member of the couple/partnership that was not present or divulged at the beginning of the relationship. Often these new sexual preferences, fantasies, and relationship dynamics leave the other partner scratching their head saying: “This is NOT what I signed up for!”

In many of these instances, one partner develops new sexual fantasies or preferences and feels a great deal of vitality or excitement wrapped up in these new thoughts or idea. This can often seem reinvigorating for the relationship (from that person’s perspective), or make you “hot” again for your partner.

Regardless of your partner’s new enthusiasms, their preferences may not be for you. These new interests may seem out of left field, or spawned by something he or she saw in a movie, or read in some steamy book. You may hear from friends or on the internet that anything out of the ordinary sexually in your relationship could be destructive or compromising. Or, alternatively that you need to meet your significant other where they are at and can’t or shouldn’t be “vanilla.”

Regardless, just as your partner is entitled to have their own sexual preferences, fantasies, kinks, hopes and dreams, so are you. Too often are we hyper critical of one partner’s experience or the other, as both experiences and realities are valid. Socially, we typically talk about sexuality as binary or totalitarian, where we function under the rule of one culturally acceptable sexual script. Remember, our experiences are broad and unique (often not paralleling societal norms), that is, there are many ways that are either right or wrong for us to be in our intimate relationships. Whether it is sexually liberal or conservative, no individual’s experience is invalid. Sexually exists on an individual as well as relational level, and in the context of your partnership, can be co-created in a preferable fashion with work and compromise.

It is difficult to be authentic, remember that. ”New” relationship or sexual desires or preferences may be a part of who someone is or was…their preferred narrative, not shared previously due to quilt, fear, or shame. Inauthenticity is everywhere…We compete with neighbors to have a more successful seeming life, compete with our appearances or our children’s accomplishments, forget about the lust we share with our partner, but aren’t true to ourselves. We’re told to be, but have incongruent adult experiences that teach us otherwise. Our true selves, beliefs, and preferences can become bottled up, and eventually overflow.

Coming to a sexual or romantic realization can be cathartic or powerful, but can seem terrifying from the outside, because it was not what we signed up for in the beginning of the relationship. Inevitably, while differing sexual preferences between partners may be incompatible, we can work toward understanding the purpose and nature of our partner’s sexual interests, and if possible, ultimately moving toward a consensual common ground where each partner is heard, understood, and validated.

If you find yourself and your partner struggling with reconciling sexual interests that were not disclosed at the beginning of your relationship, and conflict or unclear communication has ensured, couples and/or sex therapy can help!

Have you ever heard the phrase: “The definition of crazy is going around and around in circles, trying the same things over and over, but expecting different results?” Truth be told, we all have. We’re all guilty of getting stuck in problematic cycles with our partners expecting that if we try harder, yell louder, love them more, or keep explaining ourselves that things will change and get better.

When we aren’t heard or validated, are unable to share our primary emotions, or do not feel safe, we can get stuck. When disagreements are important enough or our anxieties are high enough, we will keep fighting and fighting to be heard. If nothing changes and you find yourself having the same arguments over and over, this becomes a whirlpool like process, pulling the couple further and further downward, until the relationship hits rock bottom or ends.

Regardless of the content (problems) causing these patterns of interaction between you and your partner, whether they are financial, marital, sexual, parenting, religious/spiritual, a difference in core values, or disagreeing about how the dishwasher should be loaded, couples therapy can help. There are many strategies to help intervene and solve the core problem, getting you out of the cycle and back into a preferable place together.

Couples (or partners) therapy can be tremendous helpful in interrupting problematic cycles of interaction or recurring fights about the same issue. Integrating Narrative, Emotion Focused, and Gottman couples therapy techniques, I help couples slow down, clarify communication, create shared goals, and move toward a preferable outcome. In this process, couples/partners work toward fostering greater levels of affection and trust for one another, ultimately strengthening the security of the relationship and the attachment bond.

If you find yourself and your partner getting into fights that go around in circles, struggling with “the same old issues,” and communication is only becoming worse or more heated, couples therapy can help!

Call Dr. Ethan Schwab today at (425) 295-2189 for a FREE initial consultation. Learn to communicate your preferences, needs, practices, and what is important or necessary for your relationship in ways your partner understands and welcomes.

So, what if you find yourself in a situation with your new or long term partner where you come to the realization he or she has vastly different sexual interests than you. 50 Shades fans aside, what if you find yourself discussing your very own partner’s experience with the real thing (and you never knew before)? What if he/she enjoys BDSM, cuckolding, swinging, soft swapping…etc? You may be wondering what kinks are in the first place. For many people who are uninitiated or unfamiliar in these arenas of sexual practice, the thought of your once innocent seeming partner enjoying and regularly engaging in these activities is terrifying! On top of that…what if he/she wants you to participate too? What if it is a deal breaker?

By no means is having a kinky partner (when you aren’t) a death sentence to the relationship. In many ways, it can bring excitement and growth to the relationship. At the very least, couples and partnerships in this scenario often learn to communicate far more openly about sexuality and their preferences, fantasies, and what brings them pleasure. More often than not, your kinky partner is enthralled by you, loves you, and is genuinely happy to be with you and vice versa. Just because preferences are different, doesn’t mean you aren’t enough for them. More often than not, I see couples in this circumstance where the non-kinky partner feels incompetent and that they are sexually inadequate in some way. I invite anyone in this position to consider their partner and how their interests may be in addition to you, rather than something inadequate about you.

Truth be told, even if your partner hopes you’ll participate in kinky sex, or if you are kinky hoping for your partner to participate, by no means is there only one possible outcome for the relationship. If you aren’t kinky and have no interest, that’s just fine. There isn’t anything wrong with that or you for that matter, and sexual play can be negotiated to encapsulate the interests of both partners. Granted, like all parts of a coupled relationship, compromise may need to occur. Inevitably, if you find yourself in this position, feeling intimidated and lost in what your sexual relationship will look like, fear not. Progress and fulfillment, with a little help, are very possible!

Many partners are left with the question: “What does all of this mean, and what is the purpose?”

If you are trying to answer this question, find new sexual meaning, or be better at understanding kinky partners, sex therapy can help! Call Dr. Ethan Schwab today at (425) 295-2189 for a FREE initial consultation. Learn to communicate your preferences, needs, practices, and what is erotic in ways your partner understands and welcomes.

What happens when you find yourself in a position with your partner(s) where he/she/they don’t have the same sexual intensity or drive as you? What do you do when you desire more frequent sex, or kinky sex, but your partner(s) doesn’t or is indifferent? If you’ve felt alone and isolated, you aren’t as abnormal and unique as you might think. Desire discrepancy is a common process between couples and partners when one party doesn’t possess the same drive as you. While physiological changes across the life span can impact anyone’s desire for sex (e.g., menopause, low testosterone…etc.), many life transitions can too…like becoming a parent (and being exhausted…all…of…the…time), or learning that what is or would be fulfilling sexually now is different than when you started dating or were first married.

I consistently see couples and partnerships where one partner has either a much higher drive for sex in general, or has the desire for a type of sex (often kinky sex) that the other(s) just aren’t into, or have never considered. Remember…variety is the spice of life, and despite differences in what is pleasurable between partners, it doesn’t mean that your relationship will or has to end. Regardless, it can be terrifying to hear that your partner(s) is unsatisfied with the frequency of sex or really wishes that you would be more domineering or sexually adventurous. Being in this position isn’t uncommon, and when you think about the scope of time you’ve been with your partner (especially if it’s been years), things can become stale, uninspiring, or no longer preferable.

If you have found yourself in this position, there are plenty of directions therapy can assist with. I have seen many couples who have renegotiated the nature of their sexual relationship, often to a better, more pleasurable, and more fulfilling position than it ever was at the beginning of the relationship. It is never too late to save, fix, or rediscover your sexual relationship, scripts, and chemistry with your partner!

Are You Struggling to Get on the Same Page as Your Partner Sexually?

Are you and your partner(s) struggling with a desire discrepancy? Are you trying to get on the same page or find common sexual ground? Sex therapy can help! Call Dr. Ethan Schwab today at (425) 295-2189 for a FREE initial consultation. Learn to communicate your hopes, needs, desires, and what is pleasurable in ways your partner understands and welcomes.

Regardless of the relationship or sex problems many clients bring to therapy, what keeps them from making progress is an inability to speak the same language. Most couples enter my office with one partner metaphorically speaking Latin, while the other is arguing back in German. Funny thing is, most people are saying the same thing, but do not understand one another. Achieving what you want in your relationship or sex life often cannot be achieved without speaking a common language. Whether you are fighting/miscommunicating about sex and preferences, disappointment, trust, intimacy, finances, or even how to load the dishwasher correctly, the following suggestions hold true.

Conflict is good and healthy when done “right.” Many problems I treat started small and went nearly unnoticed. One partner typically has a preference or a need he/she wants fulfilled by the other. This partner assumes that the way the couple shares its needs is clear and understood, rarely following up with the other partner(s) to ensure this is the case. Do you remember in the original Die Hard movie where Bruce Willis’ character makes the comment to Alan Rickman’s about how “assumption is the mother of all f*#k up’s?” Here is the secret; it is true in any relationship, especially with your romantic or sex partner.

When you find yourself going around in circles in conversations with your partner(s), expecting a different outcome each time (stuck in the same pattern of interaction), something needs to intervene. Often, resentment can build, and we find ourselves becoming contemptuous or critical toward the other. Those sentiments are often met defensively.

3 Ways to Speak a Similar Language

So, when you both want to speak French, but one is speaking English and the other Spanish, what can you do to stop running around in circles and move toward progress? Here are a couple of suggestions.

Try using a “soft start-up”

When you are having a difficult time having important discussions with your partner (especially about sex, or anything that usually produces an argument), try beginning conversations with a “softened start-up” or “I-statement”. Instead of blaming your partner for your own primary emotive response, begin conversations about topics needing resolution by naming what is going on for you in the situation, not what your partner is doing to you (NO blaming). For example, when you want to begin a conversation and open dialog about a desire discrepancy (where one partner wants more or different sexual activity than the other), instead of blaming your partner for not meeting your needs, you could say: “I feel disheartened when I am unable to connect physically with the person I love most in life. I need to find that shared pleasure, admiration, and closeness to feel fully alive.” See how that is fundamentally different than blaming the other party? You are taking responsibility for your primary emotions and showing your partner that when a situation (not them) occurs, something you do not prefer happens. Then, you are able to ask for help and explain to your partner(s) what you need.

This process allows each partner respectfully to begin discussing difficult topics without being immediately triggered, building up resentment for the other.

Take a “time out”

Walking away and taking a break from a heated discussion is not always a bad thing. When you feel your heart rate accelerating there is a good change you are flooded/triggered, and are losing your ability to make thoughtful/intelligent decisions, as your body starves your prefrontal cortex (the part of the brain that controls executive functioning…i.e., the smart part) of oxygen, shutting it down. After this happens, it is all fight or flight. Best to negotiate ahead of difficult discussions with your partner about taking time outs to cool down when things get too heated. Get on the same page before trying this, otherwise, it will seem like you or your partner is running away.

One caveat, be sure to return to the discussion within 24 hours so it is not forgotten. Otherwise, we build resentment.

Practice Mindfulness

Mindfulness-based Stress Reduction is a form of mindfulness that is clinically aimed at lowering anxiety through attentive breathing exercises, body scans, guided meditations, as well as other practices.

The point here is to work toward lowering anxiety and remaining present in any situation without “checking out.”

Are You Speaking a Similar Language?

Are you and your partner(s) speaking a similar language? Call Dr. Ethan Schwab today at (425) 295-2189 for a FREE initial consultation. Learn to communicate your needs and desires in ways your partner understands and welcomes.

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Learn More About Dr. Schwab’s Qualifications

As a relationship and sex therapist who treats a wide array of discomforts, it is important that I outline my professional qualifications in marriage and family, as well as sex therapy. Learn More About Dr. Schwab's Qualifications